Le FortⅢ型截骨牵引术后上气道不同截面面积变化的研究

Changes of different section area at different parts of upper-airway after Le FortⅢ osteotomy

目的通过对中面部行Le FortⅢ型截骨牵引术前、术后上气道不同截面面积的比较，评价截骨前移手术对严重中面部发育不良所致骨性上气道狭窄的治疗效果。方法自2000年以来，对11例严重中面部发育不良者，选用Le FortⅢ型颅面部截骨牵引进行治疗。术前、术后计算机辅助测量上气道不同部位二维截面面积，部分病例术前、术后行多导睡眠监测功能评估。结果所有病例面部外形及通气功能改善明显。术后后鼻棘点和腭垂尖点气道平面截面面积平均增加（210．33±219．34）mm^2和（65．14±42．24）mm^2，与术前比较，差异有统计学意义（P〈0.05）；而会厌点及气道食道分界点截面面积术后未见明显增加（P〉0．05）。结论Le FortⅢ型截骨牵引术前移中面部能有效改善因中面部严重发育不良所致的上气道狭窄，气道狭窄的改善以腭垂尖点以上气道改善最为显著。

Objective To observe the therapeutic effects of Le Fort Ⅲ usteotomy and midface distraction usteogenesis（DO） on the upper-airway narrow. Methods Since 2000, 11 cases（ 10 cases of Crouzon syndrome and 1 case of Apert syndrome） with severe midface deficiency were treated with Le Fort HI osteotomy and midface DO. The section area of different parts of upper-airway were tested by computer assistanted image measurement preoperatively and postoperatively, Some patients received sleep function monitoring, Results The face appearance and the function of upper-airway improved significantly after Le Fort Ⅲ usteotomy and Midface DO. The section area at the level of posterior nasal spine and uvula increased obviously after treatment （ P 〈 0.05）, however the section area at the level of epiglottis and separation between airway and esophagus were not obviously enlarged（ P 〉 0.05）. Conclusions Midface DO after Le Fort Ⅲ usteotomy can effectively improve the upperairway narrow, especially the upper part from uvula.